The Elevator
by midnightquiver
Summary: A special case rolls into Grey Sloan Memorial. One that shake Alex to the core. So much so that he sees the elevator. (This is written like a short, episodic piece. Only one shot.)


**This is the ONLY GA piece I'll ever write. I'm not even that sure if it's any good, but here it is. It's written so it's like one episode. Enjoy!**

* * *

The Elevator

Alexander Karev. He'd lost not one, but two women that had taken his life and thrown it into turmoil. He'd nearly lost his job. These days he ran to the test labs and did consults. He hadn't seen an operating room for the better part of the year, but hopefully that was changing soon. Hopefully. But, honestly, he wasn't counting on it. This was going to be his life, pathetically.

"No! Do you not speak English? N-O. No. How about Spanish? No."

Alex's head lowered and he shook his head. He knew that voice all too well. Casey DuVall. The girl was all fire. That's why Alex liked having her as a patient. After what went down with Deluca, her case was handed off to Jackson. Sure, he was easy on the feminine eyes, just not hers.

"Where's Alex?" Casey demanded.

"Casey, Alex is no longer handling-"

"Where. Is. Alex?" Her words were terser.

"I'm sorry. He isn't handling your case," Jackson repeated. "But-"

"Well then, I'm done here." Casey turned and made her for the exit.

Jackson stepped in her path.

"You can't leave. We need to get you set up-"

"Look," Casey pointed up at the Avery, "You're not my doctor. Alex has been my doctor since I was eight years old. We met when he was an intern. He helped me during his residency and he's still my doctor. There's nothing to talk about. If he's not my primary then I don't have a doctor. Call me stubborn, but I don't give up my people."

Alex hadn't thought about it, but it had been that long. She was one of his longest patients. This year she was eighteen.

Jackson's eyes bulged from his head and he sighed heavily.

"Wait here," he told her.

She shook her head, gesturing that she wasn't going anywhere.

Alex rearranged the folders on the desk in front of him, shaking his head. When he looked up, Casey was staring at him with a heated frown.

"You're not my doctor anymore? What did you do now?" She said, tapping her fingers on the surface.

"Hey, Case," Alex greeted.

She repeated her questions. Alex shook his head.

"I got angry," he replied simply.

"How angry?"

"I…kind of attacked a resident."

Casey rolled her eyes.

"I can't believe you," she said. "Why?"

"I told you. I got angry."

Casey sighed.

"Well, are you ready for the check-up, doc?"

"It's like Dr. Avery said. I'm not your doctor anymore."

"Karev!" Bailey boomed from behind. She gave Casey an earth bending glare, her lips pursed. She shook her head. "Casey DuVall is your patient."

She shoved Casey's file at him. It was thick from the visits over the years. All of the treatments. Casey's hair started to finally grow back two years ago. It was much finer now, but deep gold locks rested on her shoulders just barely.

"Alright," Alex said, trying not to smile. He really was glad to have a patient back. Especially Casey. He bumped her shoulder. "Let's go."

Casey hopped up onto the exam gurney and Alex on the wheeling stool.

"So, how's Jimmy?" Alex asked as he scanned over her chart.

"We broke up," she said casually with a shrug. "He said he couldn't do it anymore. It was just too difficult to date the dead."

"What an ass."

"Eh, I can't blame him."

"And your Dad?"

"Not here, obviously. Work and all. Plus, I'm eighteen. It's time I start handling this on my own."

Alex set the chart down, giving her a hard glare.

"Case, cancer is not something you should handle alone," he said. "We should call him."

"Don't. Really. It's been so hard on him. So I'll handle it. If there's something he needs to know then I'll tell him."

"You promise?" Alex's eyebrows rose.

"Promise." She kicked her feet like a kid. "So, what are we doing today?"

"Going to run a few tests to see how your body responded to the latest treatment."

"Hey, Alex?" Casey's voice softened.

"What?" He scrawled across her chart. She'd need a CT today.

"What happened? Seriously?"

"I got angry."

"It was a girl wasn't it?"

Alex sighed.

"Case."

"Okay, dropping it. BUT! If it's a girl, and you're super zipped, it must mean serious stuff. Like marriage." Alex glared. The girl loved to pry. "AND you shouldn't let her get away. I mean you attacked a guy over her."

"Case!"

"Hey, dropping it!" she said with her hands up in surrender. "Let's go not have fun."

They left the room and made their way upstairs.

"Hey, Case," Meredith greeted as they stepped in the elevator.

"Mer," Case smiled.

The CT went exactly as Alex thought it would. The cancer hadn't diminished. It was eating her most of her organs alive. And the amount of chemicals and treatments having been put into hadn't done any good. Alex pressed his hand to his mouth. He couldn't see her get put through much more.

In the other room, Casey was seeing Lady Gaga. She was claustrophobic so it helped.

"She's got some pipes," Warren said.

"Yeah," Alex replied heavy-hearted.

"Does she know?" Warren asked, pointing at the screen.

"She knows. She's known since she was eight."

"That's hard. Do you need anything. Can I help?"

"No. You can't. None of us can."

Alex leaned forward, pressing on the intercom button. Alright, Case, pulling you out."

The machine whirred and buzzed as the flat she laid on pulled her out. she sat up, dangling her feet over the edge. Her gown hung on her loosely. She moved to pull it back up onto her bony shoulder. The gown was an extra small and he didn't want to embarrass her by putting on a kid's gown.

"So?" She looked up at him, smiling. "Anything?"

Alex learned quickly after the first couple of appointments with her that she was hard to disappoint or upset. She knew the score. The likelihood that she'd make it to her twenty-first birthday. It still sucked to tell her the bad news.

"It didn't take," he said. "I'm sorry. There are other treatments."

Casey nodded, closing her eyes and exhaled slowly.

"No."

The answer was calm and collected and that was what made Alex mad. She was a fighter.

"Case, there are still treatments we can try-"

"No more, Alex. I'm eighteen. I've given enough blood to fill two people, I've given my marrow. I've lost all of my hair."

"Which grew back. It looks nice," Alex commented.

"Thanks!" She smiled. They stopped right off the elevator. "I can't keep going. I should be applying to colleges. Thinking about prom. Going to high school parties. Losing my virginity…Wait. Never mind."

She shook her head. Alex rolled his eyes.

"I can't believe you," he hissed. "You gave it away to Jimmy?"

"Eh, he felt bad." She shrugged.

Alex shook his head, disappointed.

"Hey, my body, buddy." She reminded him.

Alex backed off. He couldn't help that he felt protective over Casey. She was like a mini him. Explosive and cared way too much.

"Who's that?" She pointed into one of the rooms.

She walked in, forcing Alex to follow. Plucking his chart from the cubby at the end of his bed, she opened it.

"His name is Dylan and he has a heart condition I can't pronounce. Awaiting a heart donor." She wrinkled her nose. "That sucks. He's cute. Reminds me of that one actor a little."

Alex took the chart from her and replaced it.

"Let's go," he said leading her by the shoulders.

They returned to her room.

"Listen, Case. This is serious. It's not better, but it's going to get worse if stop trying to treat it," he told her.

"I know."

"I don't think you should leave."

"I figured."

"Call your dad."

And she did while Alex got her signed in. His hands shook as he wrote and he struggled to keep calm. His eyes threatened to let out the waterworks. He blinked quickly.

"What's wrong?" Meredith asked. She eyed him skeptically.

He looked back at Casey's open door.

"She's becoming a permanent resident isn't she?"

Alex didn't respond.

"Oh, Alex," Meredith touched his shoulder. He didn't brush it off and she came around the front desk and hugged him. "I'm sorry."

She pulled back.

"We've known Case since…" she trailed off.

"I know," Alex said. "She doesn't want treatment anymore."

"We can't force her. Her dad?"

"She's calling him now."

Meredith nodded.

"I guess we just make her comfortable," she said. She took Casey's chart from his hands. She held up the CT scans and her breath caught. "I can't believe she's hung on so long."

"It's her heart. The cancer is now starting get to her lungs, but her heart is still good," Alex explained.

Meredith closed the chart and put it in the rack.

"I don't like this. She's still a kid. This isn't right."

"She's eighteen. She made the decision," Alex said. He'd lost emotion.

Jo passed by, her head down. Alex looked away.

"Is that her!?" Casey hissed from the doorway.

Alex glared and waved for her to go back into her room.

"She's hot!" Casey hissed.

Meredith giggled, slapping Alex in the shoulder.

"It's going to get really bad Mer," Alex said. "She has less than six month if she's sure about quitting treatment."

"She's lived for so long," Meredith sighed. "Remember her first visit? You two hated each other."

"Yeah," Alex muttered.

"Meredith," April called from behind. "Baily needs you in OR 2."

Meredith sighed and turned to Alex.

"Keep me updated," she told him and then hurried off.

A month passed. Alex visited every day, making sure to check Casey's chart. A couple times he found her wandering the floor.

"Casey, you can't be bothering everybody. They have jobs," Alex stressed.

Casey held her IV on wheels pulling it with her.

"I have to move around. I'm really bored and it's not good to be lazy," she said. Jo passed them. "Hi, Jo."

Jo smiled and averted her gaze quickly. Alex's heart back flipped and swirled at seeing her.

"I knew it," Casey said. "She's the woman. She's pretty."

"Case!" He pointed backwards. "Back to your room."

She sneered, but went back to her room at a slow speed that rivaled a turtle. Warren snorted with laughter as he passed. Casey smirked, knowing that she was annoying Alex.

"You are the worst," Alex said through gritted teeth.

Month two passed. Casey still wandered around the floor, dragging her IV with her. Alex had caught her in that one kid's room a lot, Dylan. He was still in a coma. She would read to him. Currently, the book was _Valiant_. Something about some kid running away to New York City and fairy tales coming to life.

Month three passed. Casey collapsed outside of her room. Her heart stopped twice and she coughed up blood. She was confined ot bed rest. Each of the resident got a week to watch her case, When Jo's turn came around, Casey perked up and grinned.

"So you're Alex's Jo," she said.

Alex spied on the encounter from the front desk.

"I can't believe you're spying," Meredith said, smilling.

"Who's spying?" Arizona inquired, looking up from her chart. She'd visited Casey a couple times, trying to convince her to get back on treatments.

"Alex. On Casey and Jo."

"Oh god. Case is talking to Jo?" Arizona's eyebrows rose and she turned her attention to the Casey's room. they could see through the window's open blinds.

"She makes my life hell," Alex muttered. "I swear."

"Oh, Alex." Meredith laughed. It trailed off into a saddened sigh.

Casey had been a resident in the hospital for a long time. A decade. Nobody should be in the hospital that frequent. And soon enough she wasn't going to be and it hurt. Because she wasn't leaving because she was getting better.

"What is she saying to Jo?" Alex's eyes widened at seeing the two girls laugh. His jaw worked tightly.

Month four passed. Casey was sleeping more and more. Bailey had okayed giving her a morphine drip in her other arm. She had an oxygen tube attached to her nose.

"Did you read to him today?" Casey asked Warren as he wrote her current vitals on the chart.

"I will right after this, promise," he told her.

She smiled at this. Her skin had lost color a few weeks ago. Her chest moved slowly with every breath.

"Why is it so important that I read to this kid?"

"Do you ever see anybody visit him?" she asked.

Warren thought about it. He hadn't. Dylan was another case that Bailey kept him on to make sure the ventilator kept him breathing. He saw Dylan three times a day and not once did he ever have a visitor.

"No." He shook his head.

"That's why. Nobody wants to be alone."

Warren smiled. Alex walked in as he left.

"How are you feeling today?" He asked.

"Like sunshine. Bring me anything?"

He cringed and pulled out an ice cream sandwich. Casey's eyes lit up as she reached for it.

"My throat has been aching so much," she said after taking a bite.

Alex told her about the interns and how they messed up. Upon request, he told her about April and Jackson because to her, they were Shakespeare's next tragedy.

"Have you talked to her?" Casey inquired.

"Who?" His brows knitted together.

"Jo."

"Case, no. It's over. I told you."

"It doesn't look that way for you. You love her," Casey exasperated. A shiver ran over her and she held her big sweater around her tighter, curling up more. Her cheeks had become more defined and scary.

"It doesn't matter,' he said.

"It does."

Alex didn't argue with her. He went on to talk about her condition. He hated updating her, but she demanded it. Afterwards, he went and called her father again. He called every day. The man hadn't visited but twice.

"This is bullshit!" he exclaimed angrily into his phone. "She's your daughter!"

Tears welled in his eyes. Nurses and doctors froze, staring at him, but he didn't care.

Month five passed.

"Hey, Alex?" Casey swallowed hard, her breathing gravelly.

"You said that-that my heart is still pumping good."

Alex rubbed his eyes. With Casey being his only patient currently and not one that allowed him to see the OR he got some down time. He just chose to spend it in the chair in Casey's room. He didn't want to leave her alone in case…just in case.

"Yes," he said. His voice was gravelly.

"Okay," she breathed.

Alex's eyes narrowed on her. She was thinking and it didn't look good.

"Can you go get Dr. Bailey?" She smiled sweetly. Her eyes tightened and he knew that even that small movement hurt.

Alex hurried and caught Bailey as she was turning out the light in her office.

"Casey wants to see you Chief," he said, out of breath.

"Why?" she asked. "Is she okay?"

"She just said she wanted to see you."

"Well, alright."

Casey was sitting up when they returned to the room. Her hair was up in a messy bun, her breathing heavily labored. She swallowed hard.

"I want you…to…test me. Test my…heart." Casey breathed.

"Why?" Bailey's eyes softened with confusion. Alex stayed by the door, wondering what all of this was about.

"Dylan. He needs a heart….right?"

Her chest heaved a breath.

"Casey, no. You are not obligated to do that." Bailey said firmly.

"My heart…is just about…the only…thing that…works right. Use it."

Casey's brows furrowed. Talking had become hard.

"Casey, we can't."

"Does…my heart work?" Casey asked.

Bailey looked back at Alex and he just nodded. He hoped that Bailey would shut this down. The idea was completely ludicrous.

"Yes," Bailey replied.

"Do it. I'll sign whatever you want. Give it to him. Let me do something right," Casey said.

Bailey's face softened and she touched the teenager's small, frail hand.

"Karev," Bailey started.

"Bailey, you can't-"

"Karev!" Bailey boomed. "Go get a kit so we can crossmatch. Now."

Alex glared at Casey. She clutched Bailey's hand tightly.

"What's going on?" Meredith asked, peeking in. Bailey looked back at her. Arizona and Maggie stood with her.

"Good things," Casey replied when Bailey didn't.

"I can stay," Meredith started.

"No, you guys go on home." Bailey said. her voice didn't falter a beat, even though they could tell she was bothered.

"We'll stay," Arizona said.

The women turned and made their way back to the locker room. The hour ticked by and Alex returned with the results in hand. Casey had fallen asleep.

"It's a match," he said quietly.

Bailey, who was sitting in Alex's chair, stood, nodding slowly.

"Warren is reading to Dylan right now," she said.

Six hours later, Casey was awake. Bailey explained the papers that Casey was signing. Alex watched in horror as Casey signed them, but surprisingly didn't say a word today. He couldn't. They were stuck in his throat, choking him.

Then, when he did speak, he was calm, but only just. There was a quiver in his voice.

"I want in on this surgery."

"No, Karev," Bailey said as she walked toward the elevator to head upstairs.

"Bailey, this is Casey," he said.

Bailey pounded on the Up button and then spun on him.

"And that's why. It's Casey. The girl is basically your little sister and you want to help cut her heart out!? No."

Alex looked away, swallowing hard

"Please," he breathed. "Let me do something."

Bailey sighed. She closed her eyes to think.

"Fine. You can assist. Tell Jo and Edwards to prep the OR. We are doing this today. We are doing this now."

The elevator doors opened and she left him standing there. Alex's heart raced in his chest. After notifying Jo and Edwards, he went back to Casey's room. She wasn't in bed, but standing at the window. The dawn was grey and foggy. She leaned on her IV stand. Her stare was distant.

"Is it odd that I'm okay with being here? I know a hospital is not supposed to feel like home, but…" she sighed.

It did. It wasn't right. There were so many other things she should've been doing.

"Is it time?" She looked over at Alex with tired eyes.

"Mer is coming to prep you," he replied.

"Alright," she said in a whispery breath. "Hey, Alex?"

"Hm."

"Thanks." She smiled at him.

Knowing it would hurt them both, he hugged her. It was extremely careful. She hugged him in return. It was more of her grabbing his arms.

"It's been ten years, kid. Thank you," he said low.

"Case?"

Casey let go. Meredith stood in the doorway.

"Ready?"

"For the first day of the last of my life," Casey joked, saluting.

With slow steps, she walked to the bathroom. Meredith closed the bathroom door behind her.

With about twenty minutes before the surgery, Alex sat in the on call room. His head fell into his hands. Uncontrollable sob shook his body. Tears streamed down over his cheeks. He wanted to do more. There had to be something that could fix her.

"Alex?"

He turned, not having heard the door open. Jo's mouth fell open and she moved to sit beside him. She took his hand and held it, weaving her fingers with his.

"You can do this. For her," she said.

The words sounded far away.

"You have to go now," she said.

Everybody was already in the operating room. Casey was under. The heart monitor beeped steadily. He glanced up at the theater. It was crowded and he wondered how many of them actually knew who Casey was.

"Dr. Karev, are you ready?" Bailey asked.

Alex nodded.

Then suddenly, the heart monitor went flat.

"No." Bailey said, wide-eyed. "Not yet."

Alex rushed up beside Casey.

"We still have to check for lesions." Bailey said.

She called for the crash cart.

"Clear!" she shouted.

But Alex was late. His hand was still on Casey's shoulder. His body crashed into something nearby. He couldn't see. Everything went black.

* * *

When he did open his eyes he was standing in the elevator. He looked around.

"What the hell?" he squawked.

The doors dinged and opened.

Alex's mouth hung open. A numbness crept over him as he stepped out. Most of the lights were down, creating a glow on the entire floor. There was nobody here. Not a single person except…

"You are the last person I expected to see."

Alex couldn't believe his eyes. It was impossible.

"George."

That same old smile crossed George's face. Alex engulfed him in a hug immediately. He may have found George's goody act annoying, but he missed him. George chuckled and patted him on the back.

"What are you doing here?" George asked once Alex let go.

They walked a couple steps. Alex's head whipped around. Why was nobody here?

"Alex, you can't be here," George said. His eyebrows knitted with confusion.

"He's right," came another voice from behind. A female one.

Alex spun around. His eyes widened even more.

"No…it's not-"

"Possible?"

Alex stumbled a step. His eyes watered.

"Lexie." The word came out as barely a whisper.

The brunette stared up at the man with a beaming smile.

Both of them were in their scrubs and looked exactly as he remembered them.

"You have to go back. You can't stay here," Lexie said. People need you.

But he saw them and suddenly he didn't want to go anywhere. These good people didn't get to go back. He shouldn't have gotten the choice. They should've.

He was speechless for what felt like hours just looking at the two of them.

"Why are you here?" Lexie asked.

"Casey," George said.

"Ah, right. Alex you have to help her," Lexie said. "She still needs you. A lot of people do."

"Mer? She needs you. You just got you job back," George said.

"I didn't save her though. I'm helping rip out her heart," Alex snapped.

George sighed, leaning again the counter.

"It doesn't matter. None of it does," Alex said.

"None of it?" Lexie scoffed, flipping her hair back. "Alex, you've saved several lives. You can't toss that away."

"But I can't save her!" Alex shouted.

Lexie's eyes saddened and she reached up, caressing his cheek. She wiped away a stray tear from his cheek.

"That was her choice though," she said. "You know that."

Alex shrugged back from her, shaking his head violently.

"Then why can't _this_ be my choice?"

"One word." George said, crossing his arms over his chest.

Lexie and George stood in front of him. Both of them looked exhausted from trying to convince that he shouldn't do this.

"Jo." They said together.

"Don't argue." This voice chilled him to the core.

Alex tensed. Looking back, he saw Casey leaning against the elevator doors.

"You are so whiney and stubborn," she said. "And stupid."

"She makes a point," George said, smiling nervously.

Lexie nodded in agreement.

"Time to go…" Casey frowned and then laughed. "Time to go back."

She pointed over her shoulder at the metal doors of the elevator. Alex's lips pursed angrily. He shook his head. She just rolled her eyes in response.

"I get it. You're feeling low." Casey pushed herself up right. "But you don't get to stay here because of that. You gotta be strong. George is right. People need you. You don't want this."

"And you do?!" He shouted.

"I had maybe two weeks, Alex. I'm just trying to do a good thing. I would've made my way here sooner or later," Casey said, calmly.

Alex didn't even notice that she'd been pacing around him so that his back was to the elevator. He looked at George and Lexi for help. There was none. They were both in agreement. This wasn't the happy reunion with friends he was hoping. This was an intervention.

Alex didn't get to argue anymore. Casey smiled.

"See you later." She smiled and poked him in the chest.

The poke was stronger than Alex expected. He flew backwards right as the elevator doors dinged open. Alex landed on his backside. He rubbed his aching chest.

"Tell her, Alex. Try again. It's not over yet. And, don't worry about me. I'm a big girl," Casey said with a lively grin. Tears christened her eyes as she waved.

Lexie and George had already disappeared.

Alex stumbled forward, but the doors shut.

* * *

"Karev!"

Arizona's voice strained.

"There's a pulse! He's coming back!" She shouted.

Alex squinted from the bright overhead lights. Each breath burned his lungs. His eyes fluttered closed again.

The next time he opened them he was lying in a hospital bed. His chest stung. He stared up at the ceiling. He couldn't decide if it had been a dream.

"Alex?" Meredith sat up in her chair.

Alex could only grumble. At the foot of the bed, on the couch, was Jo.

"She's been visiting ever since you took a header." Meredith laughed softly. "When somebody says clear you're supposed to lift your hands."

She laughed some more.

"Did," Alex coughed. "Did it work out?"

"The donor heart?" Meredith's eyes saddened. "Yeah, Dylan woke up this morning."

Alex swallowed hard. He winced, sitting up. His chest still hurt from the defibrillator. His hand felt funny too, numb at the tips.

"You're still recovering from electrocution."

Alex nodded.

"Alex?"

"I'll go," Meredith said quickly.

She sped out of the room as Jo came forward. She rubbed her sleepy eyes.

"How are you feeling?"

"Like fried eggs," he said. It wasn't the smartest thing, but it was the first thing that came to mind. He was also hungry.

She laughed though.

"I was scared."

There was silence for a few minutes.

"Jo, I'm," he stopped. "I know it's not enough, but I'm sorry…about that night. I was out of control and I shouldn't have attacked Deluca. I know that."

It wasn't enough. The apology didn't fix any of the damage. It was a start however.

Casey's words still echoed in his head.

 _Try again._

 _See you later._


End file.
